Discussion of public health and health care policy, from a public health perspective. The U.S. spends more on medical services than any other country, but we get less for it. Major reasons include lack of universal access, unequal treatment, and underinvestment in public health and social welfare. We will critically examine the economics, politics and sociology of health and illness in the U.S. and the world.

Friday, February 08, 2013

Boring academic wankery

Our latest paper has been published on-line, and you can read the abstract here. If you really want to read the whole thing, which I doubt, send me an e-mail and I'll send you the PDF.

The abstract doesn't really do it justice. What we've done is break some outpatient visits into pieces -- all of the various issues that come up -- and keep track of how they are processed. It turns out, among other observations, that about half of them either don't require that anything be done, or there is in fact nothing that can be done. This isn't necessarily bad -- docs need to check in on stuff, people need to bring up stuff that's worrying them even if it turns out to be not a problem. It's just what it is.

Also, there are huge differences in the way the interaction looks depending on what task is being done. While we're trying to understand what's wrong or what's going on, the physicians ask a whole lot of closed questions and the patients give information in response. This actually takes up the bulk of most visits. There is also some patient education/information giving, during which patients ask more questions than do providers, no surprise, but not a lot more. When decisions are being made about treatment, doctors do most of the talking, patients seldom express their own wishes or ask questions, and doctors pretty much just say "This is what we'll do." So shared decision making or patient choice are quite scarce, at least in this data.

So that's a lot of what I do. We're pressing on with these methods now in other contexts, and I'm actually hoping to learn something. Meanwhile, when you go to the doctor, don't be afraid to speak up, and ask for an explanation of why a particular treatment is recommended -- or just given to you -- and whether there are alternatives you might want to know about. It turns out, by the way, that when that happens, people tend to end up using less drugs and getting fewer procedures. Which is probably good for you.